As part of the last competing renewal application of the parent program project P01-DE07946 (PI: John Greenspan), we sought to address emerging problems concerning the oral manifestations of HIV/AIDS. To date, our research has focused on HIV-infected populations in the US. However, we are proposing, as part of the present FIRCA application, to expand our study of the role and significance of oral manifestations of HIV infection to a setting that thus far has been understudied: sub-Saharan Africa. Because biologic assays to measure HIV disease progression are rarely accessible in sub-Saharan African countries due to prohibitive cost, other less expensive means of monitoring disease progression are needed. In US populations, visual inspection of the mouth and diagnosis of selected oral mucosal lesions have been found to be good predictors of HIV disease progression. If the predictive role of oral examination can be confirmed in sub-Saharan Africa, this would provide an important new tool for clinicians and public health specialists in this setting with respect to initiation of certain prophylactic drug regimens (such as tuberculosis or pneumocystis pneumonia prophylaxis) or anti-retrovirals. Midion Chidzonga, currently a Fogarty trainee supported by the "AIDS International Training and Research Program" Fogarty grant (2D43 TW00003-11; PI: Art Reingold; UCSF PI for the oral component in Zimbabwe: Caroline Shiboski) is conducting a cross-sectional study among HIV-infected and non-infected women in Zimbabwe to estimate oral mucosal disease prevalence in relation to HIV serostatus in this population. In collaboration with Dr. Chidzonga, we are hereby proposing to conduct a longitudinal study by expanding this ongoing cross-sectional study among Zimbabwean women. Our objectives are 1) to estimate oral mucosal disease incidence in relation to known immunologic marker of HIV disease progression (CD4 lymphocyte count); and 2) assess the sensitivity and specificity of detecting oral mucosal lesions by visual inspection of the mouth by trained nurses in a family planning/gynecology clinic in the sub-Saharan African setting. To address these objectives, we will conduct follow-up oral examinations at 6-month intervals on 225 HIV-positive participants who are being recruited into our cross-sectional study from an ongoing parent cohort study. Each participant would be seen at 6-month intervals over a 3-year period as part of the proposed study.